CLARKE WILSON MANGUN JR MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****46

License Status

NOT RENEWED

Business

First Name

CLARKE

Middle

WILSON

Last Name

MANGUN

Suffix

JR MD

Business Name

CLARKE WILSON MANGUN JR MD

Original Issue Date

01/01/1997

Expiration Date

07/31/2005

City

PARK RIDGE

State

Zip

60068

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/07/2011